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WHAT YOU NEED TO KNOW:
What is gout?
Gout is a form of arthritis that causes severe joint pain and stiffness. Acute gout pain starts suddenly, gets worse quickly, and stops on its own. Acute gout can become chronic and cause permanent damage to your joints.
What causes gout?
Gout develops when uric acid builds up in your joints. Uric acid is made when your body breaks down purines. Purines are found in some medicines and foods. Your body gets rid of most uric acid through your urine. When your body cannot get rid of enough uric acid, it can build up and form crystals in your joints. The crystals cause your joints to become swollen and painful. This is called a gout attack.
What increases my risk for gout?
You may have been born with a decreased ability to break down and get rid of purines. Your body's ability to break down purines may be very slow. Gout is more common in men than in women. Any of the following can also increase your risk:
- A family history of gout
- Kidney disease or problems with how your kidneys work
- Eating foods that are high in purines, such as red meat
- Alcohol or tobacco use
- Diuretic medicine (water pills), or aspirin
- A medical condition such as diabetes, high blood pressure, or high cholesterol
- A condition such as an irregular heartbeat or a blood clot in your lungs
What are the stages of gout?
- Hyperuricemia is a high level of uric acid. Hyperuricemia is not gout, but it increases your risk for gout. You may have no symptoms at this stage, and it usually does not need treatment.
- Acute gouty arthritis starts with a sudden attack of pain and swelling, usually in 1 joint. This may be in your big toe. The attack may last from a few days to 2 weeks.
- Intercritical gout is the time between attacks. You may go months or years without another attack. You will not have joint pain or stiffness, but this does not mean your gout is cured. You will still need treatment to prevent chronic gout.
- Chronic tophaceous gout develops if gout is not treated. Large amounts of uric acid crystals, called tophi, collect around your joints. The crystals can destroy or deform the joints. Gout attacks occur more often, and last hours to weeks. More than 1 joint may be painful and swollen. At this stage, gout symptoms do not go away on their own.
How is gout diagnosed?
Your healthcare provider will ask about your medicines, health problems, and allergies. Tell him or her when your joint pain and swelling started. He or she will need to know if the swelling and pain were worst within 1 day or if got worse over time. He or she will check the skin over your joints for redness. You may also need any of the following:
- Blood tests are used to check the level of uric acid. You may need to have blood tested more than once.
- A synovial fluid test is used to collect a sample of fluid from around your painful joint. The fluid is sent to a lab to check for uric acid crystals. Synovial fluid surrounds and protects your joints.
- An x-ray, ultrasound, CT, or MRI may show the gout or damage to bones caused by gout. You may be given contrast liquid to help your joints show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
How is gout treated?
The following can make your symptoms stop sooner, prevent attacks, and decrease your risk for joint damage:
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Gout medicine decreases joint pain and swelling. It may also be given to prevent new gout attacks.
- Steroids reduce inflammation and can help your joint stiffness and pain during gout attacks.
- Uric acid medicine may be given to reduce the amount of uric acid your body makes. Some medicines may help you pass more uric acid when you urinate.
- Surgery called a bone graft may be needed for tophi that are painful or infected. Bone in the joint may be replaced with bone taken from another place in your body. Ask your healthcare provider for more information about bone graft surgery.
How can I manage my symptoms?
- Rest your painful joint so it can heal. Your healthcare provider may recommend crutches or a walker if the affected joint is in a leg.
- Apply ice to your joint. Ice decreases pain and swelling. Use an ice pack, or put crushed ice in a plastic bag. Cover the ice pack or bag with a towel before you apply it to your painful joint. Apply ice for 15 to 20 minutes every hour, or as directed.
- Elevate your joint. Elevation helps reduce swelling and pain. Raise your joint above the level of your heart as often as you can. Prop your painful joint on pillows to keep it above your heart comfortably.
- Go to physical therapy if directed. A physical therapist can teach you exercises to improve flexibility and range of motion.
How can I help prevent gout attacks?
- Do not eat high-purine foods. These foods include meats, seafood, asparagus, spinach, cauliflower, and some types of beans. Healthcare providers may tell you to eat more low-fat milk products, such as yogurt. Milk products may decrease your risk for gout attacks. Vitamin C and coffee may also help. Your healthcare provider or dietitian can help you create a meal plan.
- Drink liquids as directed. Liquids such as water help remove uric acid from your body. Ask how much liquid to drink each day and which liquids are best for you.
- Maintain a healthy weight. Weight loss may decrease the amount of uric acid in your body. Ask your healthcare provider how much you should weigh. Ask him to help you create a weight loss plan if you are overweight.
- Control your blood sugar level if you have diabetes. Keep your blood sugar level in a normal range. This can help prevent gout attacks.
- Limit or do not drink alcohol as directed. Alcohol can trigger a gout attack. Alcohol also increases your risk for dehydration. Ask your healthcare provider if alcohol is safe for you.
When should I seek immediate care?
- You have severe joint pain that you cannot tolerate.
- You have a fever or redness that spreads beyond the joint area.
When should I call my doctor?
- You have a fever, chills, or body aches.
- You are confused or more tired than usual.
- You have new symptoms, such as a rash, after you start gout treatment.
- Your joint pain and swelling do not go away, even after treatment.
- You are not urinating as much or as often as you usually do.
- You have trouble taking your gout medicines.
Care AgreementYou have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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